title: Influence of tumour-associated symptoms on the prognosis of patients with renal cell carcinoma.
abstract: OBJECTIVE
  To evaluate the prognostic significance of symptoms related to renal cell carcinoma (RCC) in comparison with incidentally detected tumours in a group of long-term observed patients.
  
  
  METHODS
  The study included 396 patients operated for RCC between 1982 and 2001. The patients were classified according to age, gender, detection mode, pathological stage and grade, tumour size, nodal involvement and Eastern Cooperative Oncology Group (ECOG) performance status. Special attention was given to the analysis of duration and quality of symptoms. The endpoint of the study was overall survival, which was assessed with univariate and multivariate analyses using the Kaplan-Meier method, log-rank test and Cox proportional hazards model.
  
  
  RESULTS
  Of the 396 patients, 135 (34%) and 261 (66%) presented with incidental and symptomatic RCC, respectively. Compared with incidental cases, symptomatic tumours had significantly larger size (p < 0.0001), and higher pathological stage (p < 0.0001) and grade (p < 0.02). Five-year survival in patients with incidental and symptomatic tumours was 88.1% and 59.4% (p < 0.0001), respectively. In relation to the quality of symptoms, the 5-year survival in patients with local and systemic symptoms was 75.4% and 44.4% (p < 0.0001), respectively. In the group of patients with a history of tumour-related symptoms shorter and longer than 3 months, the 5-year survival was 62.2% and 55.6% (p < 0.0001), respectively. Multivariate analysis found tumour size [hazard ratio (HR) 1.22, p = 0.05] tumour grade (HR 1.44, p = 0.002), tumour stage (HR 1.35, p = 0.001), presence of symptoms (HR 1.36, p = 0.004) and ECOG (HR 1.25, p = 0.005) to be independent prognostic variables.
  
  
  CONCLUSIONS
  Preoperative somatic symptoms and performance status in patients with RCC provide readily available prognostic information in addition to tumour size, stage and grade.
authors.affiliation: Department of Urology, 2nd Faculty of Medicine, University Hospital in Motol, Prague, Czech Republic. ivan.kawaciuk@lfmotol.cuni.cz
authors.forename: Ivan
authors.initials: I
authors.lastname: Kawaciuk
authors.forename: Lubomir
authors.initials: L
authors.lastname: Hyrsl
authors.forename: Pavel
authors.initials: P
authors.lastname: Dusek
authors.forename: Ladislav
authors.initials: L
authors.lastname: Jarolim
authors.forename: Marek
authors.initials: M
authors.lastname: Schmidt
authors.forename: Veronika
authors.initials: V
authors.lastname: Kaliska
authors.forename: Matus
authors.initials: M
authors.lastname: Chocholaty
authors.forename: Stepan
authors.initials: S
authors.lastname: Vesely
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate